Guest Form

Holidays

Your Details

Next of Kin Details

GP Details

Guest Information

Medical Conditions

Please indicate if you have any of the following:

If so, when was the date of your last seizure: How often are your seizures?
If yes, please provide details:

I need assistance in the following areas

Care Plan

FOR YOU TO BE ACCEPTED ON THIS HOLIDAY WE WILL REQUIRE AN UP-TO-DATE CARE PLAN.

Additional Information

Data Protection

Under the data protection regulations 1998 and to comply with new regulations coming into effect from 25 May 2018, we need your consent in respect of the following, and would be grateful if you would tick your agreement in the boxes provided:

1. All your personal data shall be kept confidentially by 3H for a time deemed necessary. 2. 3H will forward your personal data to the necessary parties who will have been made aware of their obligations to abide to all aspects of the new data regulations and particularly in respect of confidentiality and safe keeping. 3. 3H Fund may wish to publish photographs with your first name and/or short video clips which include you, in their various publications, 3H website, Facebook, Twitter and may use your details for other promotional and reporting purposes.

Under the new regulations you have the right to request personal data held about you by us and following your request this information will be returned to you within a month.

3H - Helping Hands for Holidays